Surgical Management of Lymphatic Leakage

Lymphatics are found in almost every organ in the body, and they produce a variety of waste products that must be eliminated. lymphatic leakage is a typical occurrence. It can cause immunodeficiency as well as nutritional issues. Furthermore, it has a significant morbidity and death rate, depending on the existence of an underlying illness. Lymphatic leakage can be congenital, traumatic, or cancerous, and occurs when the lymphatic system is disrupted. It might take the following forms: Chylothorax, Lymphatic Fistula, Chylous Ascites. treatment of lymph leaks includes: reduction of lymphatic flow through physiological or pharmacological manipulation; replacement of fluid and electrolytes, as well as interventional procedure and/or direct surgical closure. In this review we’ll be discussing lymphatic system anatomy, its leakage and its management.

Update on Febrile Neutropenia in Pediatric Oncological Patients Undergoing Chemotherapy

Febrile neutropenia (FN) is a common complication of chemotherapy in oncological children and one of the most important causes of morbidity and mortality in these patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome. We analyzed the literature in order to clarify the epidemiology of FN in children undergoing chemotherapy, the specific factors associated with a negative outcome, the most common etiology, and the value of biological markers as a tool to make an early diagnosis or to monitor the evolution of the infection. Several studies have tried to identify specific factors that could help the clinician in the detection of an infection and in its microbiological identification. However, due to the heterogenicity of the available studies, sufficient evidence is lacking to establish the role of these risk factors in clinical practice and future research on this topic appear mandatory. Determinations of risk factors, etiology, and markers of febrile episodes in these patients are complicated by the characteristics of the underlying illness and the effects of treatments received. Although some studies have tried to develop an evidence-based guideline for the empiric management of FN in pediatrics, validated predictive scores and algorithms are still lacking and urgently needed.

Etiology and Management of Hypoventilation Syndromes

A number of diseases affecting central ventilation, breathing mechanics or both, characterize hypoventilation syndromes. The incidence of hypoventilation syndromes varies according to the underlying reason. The hypoventilation syndrome's clinical symptoms are generally vague and are in most cases due to the underlying clinical condition. More individuals develop hypercapnia and hypoxemia as hypoventilation continues to worsen. Therefore, clinical indications of hypoxemia such as cyanosis, and evidence of hypercapnia may also be present. Regardless of the etiology, successful hypoventilation therapy focuses on the underlying illness and noninvasive ventilation. Treatment for these diseases includes integrated main disorder treatment and, increasingly, non-invasive positive pressure breathing. In this paper, we overview current evidence regarding different etiologies and management of hypoventilation syndromes. Data was collected during the period of 6 months searching Pubmed, EPISCO, Web of science, Google scholar databases to include papers with relative topics.

Gastrointestinal Symptoms

Patients with advanced illness often carry a high gastrointestinal symptom burden. These patients are at risk for poor oral health secondary to polypharmacy and limited access to appropriate dental care. Oral health directly correlates with overall health of patients. Nausea, vomiting, and constipation are common symptoms that initiate referrals to palliative care. Patients at the end of life and/or with advanced illness will likely experience gastrointestinal dysmotility related to their underlying illness and medications. Providers need to be adept at recognizing symptoms and starting the appropriate palliative measures. Addressing these symptoms appropriately can result in improved quality of life and significant reduction in morbidity for patients. A stepwise evidence-based approach is required to successfully manage these symptoms in patients undergoing curative, maintenance, and/or palliative therapy.

Venous Thromboembolism among Critically Ill Children: A Narrative Review

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality among hospitalized patients, including children. In recent years, it has become clear that hospitalization and critical illness bestow an increased VTE risk in pediatrics and relate to mortality and life-limiting comorbidities. For critically ill children, reported rates of VTE vary by study sampling techniques, presence of inherited or acquired thrombophilia, acute and chronic immobility, underlying illness prompting hospitalization, and clinical factors related to illness severity such as central venous catheterization, length of stay, mechanical ventilation, and patient age. Accordingly, critically ill children with new signs of venous congestion, acute inflammation, or unexplained acute organ dysfunction should be routinely evaluated for VTE. This narrative review summarizes recent and historical literature regarding risk factors, prevention, presentation, treatment, and outcomes of VTE in critically ill children. In addition, we identify knowledge gaps and priorities for future collaborative research on this vital condition. Special attention is given to the clinical trial opportunities, challenges, and ongoing efforts in thromboprophylaxis in critically ill children, including those hospitalized for disease related to novel coronavirus (COVID-19) and multisystem inflammatory disease in children.

TO FIND OUT THE COLONIZATION OF CLOSTRIDIUM DIFFICILE IN PATIENTS WITH MORE THAN 48 HOURS OF ADMISSION AND HAVING GASTROINTESTINAL SYMPTOMS

Background & Method: Place of Study in Department of Microbiology, Gajra Raja Medical College, Gwalior Study was conducted on 600 patients admitted in various wards in G.R. Medical College, Gwalior and associated J A Group of Hospital Gwalior (MP). Result: Among 600 suspected patients studied, maximum number, 287 (47.83%) belong to age group 19-49 years and minimum number 20 (3.33% belong to more than 75 years age group. Male were more (58.83%) than female (41.16%) in studied suspected patients. Fever was the most prevalent presenting symptom with 350 (58.33%) suspected patients. This was followed by abdominal pain 200 (33.33%) patients and diarrhoea in 118 (19.67%) suspected patients. The least culture positivity was found in suspected patient who had admitted for 3-10 days (2.42 %). The maximum number of positive culture were found in patients with hospital stay more than 26 days which mean that duration of hospital stay correlate with positivity of culture. difficile was isolated in 5.71 % of the gastric acid suppressants using patients while its positivity in non gastric acid suppressants user was 2.72 %. Conclusion: The prevalence of C. difficile in 600 hospitalized patients was found to be 5.17%.in our hospital. It was less as compare to other studied conducted earlier. Cause of less prevalence may be due to various factors like the decreased use of Clindamycin in our hospital. Secondly, antibiotics effective against C. difficile such as Metronidazole have been included as the first line drugs in suspected CDAD cases. Colonization of C. difficile has been traditionally associated with hospitalization, advance age, underlying illness, gastric acid suppressant use and most prominently to use of antimicrobials. Uses of antibiotics, long stay in hospital and advance age was the most common risk factor in our study. Keywords: colonization, Clostridium difficile & gastrointestinal.

Comparison of Clinical, Laboratory and Immune Characteristics of the Monophasic and Biphasic Course of Tick-Borne Encephalitis

The biphasic course of tick-borne encephalitis (TBE) is well described, but information on the monophasic course is limited. We assessed and compared the clinical presentation, laboratory findings, and immune responses in 705 adult TBE patients: 283 with monophasic and 422 with biphasic course. Patients with the monophasic course were significantly (p ≤ 0.002) older (57 vs. 50 years), more often vaccinated against TBE (7.4% vs. 0.9%), more often had comorbidities (52% vs. 37%), and were more often treated in the intensive care unit (12.4% vs. 5.2%). Multivariate logistic regression found strong association between the monophasic TBE course and previous TBE vaccination (OR = 18.45), presence of underlying illness (OR = 1.85), duration of neurologic involvement before cerebrospinal fluid (CSF) examination (OR = 1.39), and patients’ age (OR = 1.02). Furthermore, patients with monophasic TBE had higher CSF levels of immune mediators associated with innate and adaptive (Th1 and B-cell) immune responses, and they had more pronounced disruption of the blood–brain barrier. However, the long-term outcome 2–7 years after TBE was comparable. In summary, the monophasic course is a frequent and distinct presentation of TBE that is associated with more difficult disease course and higher levels of inflammatory mediators in CSF than the biphasic course; however, the long-term outcome is similar.

Necrosis esofágica aguda en pacientes post trasplante hepático. Un túnel oscuro desde el hígado al esófago

Acute esophageal necrosis is a rare entity endoscopically described as a black appearance of esophageal mucosa, generally of circumferential distribution that extends proximally from the gastroesophageal junction, and affects a variable length of this organ. It has a multifactorial etiology that includes a combination of ischemic mucosal esophageal vascular compromise associated with gastroesophageal reflux in patients with multiple comorbidities. Clinical management focuses on general support measures and treatment of the underlying illness and comorbidities. Although this pathology usually tends to a restitution-ad-integrum in 7-10 days, these patients have a high mortality rate more related to their clinical conditions and not due to this entity itself. Therefore, early diagnosis is crucial to initiate proper treatment. We present two cases of AEN in patients who underwent orthotopic liver transplantation.

The Psychological Consequences of COVID-19 Fear and the Moderator Effects of Individuals’ Underlying Illness and Witnessing Infected Friends and Family

The COVID-19 virus has become a fearful epidemic for people all over the world. In Turkey, long quarantine periods and curfews have increased both physical and psychological problems. Due to the rapid spread and substantial impact of the COVID-19 virus, different psychological effects were observed among different segments of society, such as among young people, elderly people, and active workers. Because of fear caused by the COVID-19 virus, it is thought that depression, stress, and anxiety levels have increased. It is estimated that there are more psychological issues for people with poor health and others whose friends or family became ill or have died because of COVID-19. To explore and test the situation mentioned above, we conducted a cross-sectional study in Turkey with 3287 participants above 16 years old. We measured COVID-19 fear, along with anxiety, stress, and depression levels (DASS21) and demographics. Firstly, we tested whether COVID-19 fear predicts stress, anxiety, and depression. Secondly, we investigated if the effect of COVID-19 fear is stronger for those who have underlying illness and for those whose friends or family became ill or have died because of COVID-19. The results showed that women and 16–25 years old youths have higher COVID-19-related fear, anxiety, depression, and stress. Furthermore, we found a significant relationship between COVID-19 fear and stress, anxiety, and depression, as well as significant moderation effects of having an underlying illness and having friends or family who were infected or have died. These results show the importance of implementing specific implementations, particularly for vulnerable groups, to minimize the psychological problems that may arise with the pandemic.